SOME DOCTORS ASK THEM TO SEEK CARE ELSEWHERE
Monday, September 5th 2016
Some Lancaster County doctors are either dropping or refusing to welcome families that won’t vaccinate their children, to protect patients from communicable diseases The practice, which raises ethical questions and faces criticism from affected parents, was recently approved by the American Academy of Pediatrics as a last resort if all persuasive efforts fail.
“Parents, pediatricians, and policy-makers all have a role here in protecting children from diseases like measles and whooping cough,” wrote the national association’s President Dr. Benard P. Dreyer. “As pediatricians, we care about every individual child in our practices, and we know that vaccines are an important way to protect them from disease.” The organization also called on states to tighten laws to make it harder for parents to refuse vaccination on non-medical grounds.
Pennsylvania is one of 20 states that allow “philosophical exemptions” to vaccination; those can be obtained with a one-line explanation and a parent or guardian’s signature. Religious exemptions can be obtained the same way.
Dr. Melissa Tribuzio of Red Rose Pediatric Associates in Lancaster says the practice dismisses families who choose not to vaccinate. “We feel that we are unfairly asking them (other patients) to put their children at risk if we are knowingly continuing to perpetuate a non-vaccinated population in our waiting room,” she said.
The risk is especially high for infants too young to be vaccinated, children who cannot be vaccinated because of medical problems, and those for whom vaccinations are less effective, she explained. Last January, Tribuzio noted, there was a “potentially lethal exposure” after a person suspected to have measles — eventually tested negative — came to the building that the practice shares with another one that treats cancer patients.
“Measles is so contagious that that kid being in the elevator within four hours of any cancer patients is a big deal,” she said, noting that several babies had to be given preventative drugs earlier than recommended as a result. Since then, her office has been “more upfront” about informing prospective patients about its policy.
Some practices, like WellSpan Family and Pediatric Medicine in Rothsville and Roseville Pediatrics in Lancaster, aim for a middle ground by requiring parents to sign refusal forms or waivers that say they’ve been informed that not vaccinating puts their child and others at risk of illness or death.
At the receiving end
At the receiving end are parents who believe they are exposing their children to risk by vaccinating them — which doctors and researchers emphasize is not supported by extensive scientific studies. Crystal Hunsicker, of Manheim, says she was dismissed from Eden Park Pediatric Associates because she refused vaccines for her child.
“If there is a risk, there needs to be a choice,” said Hunsicker, who believes vaccinations administered by a different medical practice are the reason one of her children is blind. “Those of us who don’t want to take that risk shouldn’t be forced to,” she said. And after asking around, Hunsicker found a practice where she is welcome and comfortable.
Dr. Maggie Knox-Lee, a partner at Eden Park, said privacy laws prohibit discussion of specific cases, but she directed LNP to the immunizations policy posted on the practice’s website. According to that policy, parents who refuse to vaccinate will be asked to find another health care provider who shares their views. However, parents often respond positively after long discussions with doctors, Knox-Lee said.
Hunsicker is forming to group called the Pennsylvania Medical Freedom Alliance to fight legislative proposals that would beef up Pennsylvania’s school immunization requirements and do away with the religious and philosophical exemptions that many now claim.
Another unhappy parent is Rebecca Butler, a Quarryville resident who believes vaccines contributed to her son’s autism. Doctors, government and schools should not be pushing vaccines, she said. While never physically asked to leave a practice, she reports having left some after butting heads with physicians over the issue, and said a doctor once threatened to call Children and Youth. Both Hunsicker and Butler said if non-medical exemptions were outlawed here, they would move.
Dismiss vs. engage
While some doctors think dismissing patients from practice is the right move, they acknowledge it is not an easy decision. Dr. Benjamin Levi,a pediatrician at Penn State Children’s Hospital and an ethicist at Penn State College of Medicine, said dismissing solely on the grounds of vaccine refusal strikes him as problematic, particularly if it’s pre-emptive.
“Where will these children and their families go? Will they go to somebody who is equally well-trained? Will the burden be placed on other practices that are not exclusionary?” he said. “Those matters it seems to me are often not fully thought out in making these decisions.”
Engagement should be the first step in his mind. “If we’re going to win the day in protecting children, the way we do it is engaging people rather than by dismissing them.” However, he said, there are legitimate reasons to dismiss patients, lack of trust being an important one.
Tribuzio, who practices at Red Rose Pediatric Associates, says she understands “the argument that at least if they’re in my practice, I might be able to help them eventually move toward immunizing their child.”
But, she said, in her experience those who have already made up their minds to refuse all vaccinations are generally not swayed by discussions with doctors. The evidence supporting vaccines is “absolutely black and white,” according to her.
“If you can’t trust me in something that’s that black and white, I have a hard time believing that we’re going to have a therapeutic relationship in things that are more gray,” she said. Dr. Vinitha Moopen, who works at the WellSpan practice, said she supports the new national guidelines and finds it disheartening when despite her best efforts, parents refuse to vaccinate or sign the form.
“We need to vaccinate as many children as possible so we can prevent these diseases,” she said.